Complications of PC
1. Corneal Abrasions: In a survey of permanent makeup instructors taken in 1997, a 40% incidence of corneal abrasions was reported. Dr. Charles S. Zwerling, MD states that it is probably closer to 100% of technicians that have experienced a client with a corneal abrasion. Dr. Zwerling goes on to state “the reason corneal abrasion is not reported more frequently is that the signs and symptoms are not recognized by many dermatechnicians”. With the advent of topicals with a physiologic pH range of 7.4-7.69 (Numquick™ Purple, DOTC Blue™), corneal abrasions are largely limited to those inflicted mechanically or from other chemical factors.
Signs of corneal abrasion include a sensation of a “rock in my eye” or a gritty sensation, sensitivity to light, pain and blurred vision. Practitioners should refer their patient or client to an eye care physician or Emergency Room immediately.
Such a complication is an embarrassment to the practitioner and physicians have expressed concern about non-medical professionals performing permanent eyeliner procedures.
2. Allergic Reactions: Antibiotic ointments, latex, nickel and pigments head the list of allergic reactions related to permanent makeup procedures. Allergic reactions can be either immediate or delayed and both types have been reported in the literature. Glycerin may rarely elicit an allergic reaction.
Lipcolors can be a problem in permanent cosmetics. Rare but real, an allergic reaction to red or yellow can be disastrous for the client, technician and the manufacturer of the problem pigment. Referral to a physician for prompt diagnosis and treatment is the standard of care. Do not try cortisone ointments or “bleeding out the color” by over-tattooing the area. A tiny punch biopsy will reveal the diagnosis and determine further treatment.

Permanent makeup, unlike traditional tattooing, often requires two or three sessions to achieve the desired result. Seasoned tattoo artists are the first to admit that tattooing on the face is much more difficult than other parts of the body. Always exposed to the sun and environment, the face provides a tough, yet vulnerable “canvas” in which to implant color. Inks cannot be used on the face as readily as the body and pigments do not “fly” into the skin as readily as inks.
Few artists would consider starting their painting on a canvas with blue, yellow, red or green backgrounds. Yet that is the challenge facing the permanent makeup artist. The end result may vary widely from the desired result after the skin has healed and the colors have been subjected to the body’s environment. Raspberry brows, purple lips and blue (not black) eyeliner reflect the inability of the practitioner to predict with surety the combination of various pigments when placed into, not onto, the facial skin.
Permanent cosmetics are not easily removed or camouflaged. Practitioners are often faced with the need to correct their own work and the work of others. Fortunately, more resources are available to guide in color and pigment selection than ever before. Practitioners learn quickly how certain pigments behave and “word of mouth” advice flows quickly about remedies and favorite suppliers. It is important to realize that permanent makeup is still a young profession and no controlled studies exist with regard to pigments.

Colors
Talc-free pigments, whether iron oxide or organic are vital to prevent foreign body reactions. The debate continues about the safety of inorganic versus organic pigments and particle size of pigments used in permanent makeup. Because no pigments for tattooing are FDA approved, the suppliers of pigments are largely responsible for the purity and safety of the colorants used in their products.
Inert colorants, dyes, iron oxide, carmine and organic pigments are readily available from various sources. Most labeling of these colors does not reflect the ingredients contained in the pigments and their dispersal agents. Some even say “Not for Implanting Into the Skin”. Little attention is paid to such warnings by practitioners.
Commonly, dispersal agents have included alcohol, witch Hazel, castor oil, propylene glycol, glycerin, distilled water, and alkalinizing or acidifying solutions needed for a colorant to stay in solution. The use of alcohol, Witch Hazel and high or low pH inks and dyes causes severe burning of the eyes and corneal damage. A pH neutral, alcohol-free dispersal agent for colorants needs to be perfected for use on eyeliner.

Pain Control
Women who would otherwise enjoy the benefits of permanent cosmetics have avoided the procedures due to the pain which they fear they would have to endure. Ice cubes, Valium, pain killers and designated drivers were required by those who underwent permanent makeup prior to 1996 and the advent of topical anesthetic creams and gels which are both safe and effective. Dentists are rarely needed for “dental block” anesthesia for lipcolor.
With safe and effective topicals DOTC Blue™, NumQuick™ Purple and TAG#45 Gel to control pain, swelling and bleeding, clients enjoy excellent analgesia and practitioners are able to work faster with less stress.
In a 1993 written statement concerning eyeliner safety, the FDA acknowledged that local anesthetics are routinely used in permanent makeup procedures. There are no final monographs (regulations) for local anesthetics considered safe and effective for OTC use except for preparations for diaper rash, anorectal discomfort and male genital desensitizers.

Bacteria possess certain characteristics such as: some require oxygen to live, they are known as Aerobic. Those that do not are know as Anaerobic. There are bacteria that are called Thermostabile, which means that they are not easily altered or decomposed by heat… those that are Thermolabile are easily decomposed by heat.
You will also come across the term spore. A spore is a reproductive cell produced by plants and some protozoans – it is the asexual reproduction of many unicellular animals and plants. These spores possess thick walls enabling them to withstand unfavorable environmental conditions such as extreme heat.
Certain bacteria form spores but more in the nature of a defense mechanism than for reproduction. These spores are difficult to destroy because they are very resistant and require prolonged exposure to heat to destroy them.
So, as we see, some bacteria love heat, and if they are spore formers, high heat alone will not do the job, so dry heat is out.
Some sterilizers utilize boiling water and steam in an unsealed receptacle know as “flowing steam”… temperature 212° F (IOO C)… this is also inadequate. Boiling water alone is good for tea and coffee but useless against bacteria.
Exposing the article to heat and steam at intermittent intervals, called tyndal-ization… is another inadequate procedure.
How about sterilization by gas, e.g., ethylene oxide. Great, but too explosive. Or formaldehyde… again, great, but formaldehyde is trapped in a ruling right now linking it as a carcinogen (able to cause cancer); also too dangerous.
We are narrowed down to the autoclave, the instrument of choice, that kills not only bacteria, but also spores.
To autoclave properly, we must first understand the mechanics of the system. This employs a temperature of 273° F, with steam under pressure of 15-17 pounds per square inch (PSI) for 30 minutes (50 minutes from cold start) and a 15 minute cool down or drying period (the door can be open about 1″ during this period).

If no friends are to be found, you can stretch a large area by using the outside of your left palm, ring and little finger to push upwards. Use your little finger and the outside of your right palm to pull down as you tattoo with the same hand. This is easier than it sounds and it gets easier with practice.
These elaborate stretching procedures are mainly for the outline, so you don’t smear any of the lines on the stencil before it has been all outlined. Once the outline is on, you can easily stretch small areas of skin as you proceed through the rest of the operation, using your left hand as illustrated, to do the stretching.
A short word is in order here about some of the first skin you will come in contact with. You will need some skin to practice on. You are going to need some skin of some kind to learn on and get the basic feel of things. In the beginning, start on yourself. If you are right handed, you can cover most of your left arm and both legs yourself. Why not? You want to tattoo don’t you? Let’s not get squeamish. It’s better to make mistakes on yourself first than other people. If you plan to make a career in tattooing, you’ll find it difficult to market a product which you yourself don’t endorse. Once you’ve covered yourself with fine tattoos, it’s time to start looking for friends. You can always find people to work on for free, who aren’t that particular at first. Usually a deal can be made where if you tattoo them for free, they will advertise around where they got it. It’s a good form of practice for you. They get a good free tattoo, you get to work on different people, and you also get the benefit of some free advertising.